Frequency, Duration, and Predictors of Newly-Diagnosed Atrial Fibrillation Following Dual-Chamber Pacemaker Implantation in Patients Without a Previous History of Atrial Fibrillation††Conflicts of interest: Dr. Mittal is a consultant for Biotronik and LifeWatch Corporation, Rosemont, Illinois; has received fellowship support from Boston Scientific Corporation, St. Paul, Minnesota, and Medtronic, Minneapolis, Minnesota; and has received speaking honoraria from Boston Scientific Corporation, Medtronic, and St. Jude Medical, St. Paul, Minnesota. Dr. Stein has received speaking honoraria from Boston Scientific Corporation, Medtronic, and St. Jude Medical and is a member of the advisory boards of Boston Scientific Corporation and Medtronic. Dr. Gilliam is a consultant for, has received speaking honoraria from, is a member of the advisory board of, and has received research funding from Boston Scientific Corporation. Stacia Merkel Kraus is a consultant for Boston Scientific Corporation. Drs. Meyer and Christman are employees of Boston Scientific Corporation.

A 45-year-old woman with no previous history of cardiac disease woke up one morning with an irregular heartbeat and fatigue. An electrocardiogram showed atrial fibrillation and plain chest radiographs revealed the presence of a metallic pin at the position of the heart. A 24 mm-long metallic pin was removed by open thoracic surgery from within the right ventricle of the heart. Postoperative examination of the pin showed it to be one of the 0.8 mm Kirschner wires that had been used for finger osteosynthesis in her left hand 31 months previously.

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Determinants of development of permanent atrial fibrillation and its treatment

EP Europace ◽

10.1053/eupc.1998.0008 ◽

1999 ◽

Vol 1 (1) ◽

pp. 35-39 ◽

Cited By ~ 11

Author(s):

L. Gianfranchi ◽

M. Brignole ◽

C. Menozzi ◽

G. Lolli ◽

N. Bottoni

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Risk Group ◽

Pacemaker Implantation ◽

Structural Heart Disease ◽

High Risk Group ◽

Symptom Duration ◽

Permanent Atrial Fibrillation ◽

History Of

Abstract We evaluated the rate of progression of permanent atrial fibrillation (AF) and identified clinical factors that predict this event in 63 consecutive patients who had undergone AV junctional ablation and DDDR pacemaker implantation for drug-refractory paroxysmal atrial fibrillation/flutter. Immediately after ablation, anti-arrhythmic drugs were discontinued in all cases. Permanent AF was con-sidered to have developed if AF was present on two consecutive 6-monthly examinations with no interim documented sinus rhythm. During a mean follow-up of 23±16 months, 22 (35%) of the 63 patients developed permanent AF. The actuarial estimate of progression of permanent AF was 22%, 40% and 56%, respectively, 1, 2 and 3 years after ablation. Age and underlying heart disease were independent predictors of progression of permanent AF. Only one (6%) of 16 patients with idiopathic AF had permanent AF (low risk group). Among the 47 patients with structural heart disease, permanent AF developed in 18 (62%) of the 29 who were aged >75 years or had >12 arrhythmic episodes per year and a symptom duration >4 years (high risk group), but only in three (17%) of the remaining 18 patients who did not (intermediate risk group). In conclusion, during a 3-year follow-up period, about half of the patients with a history of drug-refractory paroxysmal AF did not develop permanent AF after AV junctional ablation and dual-chamber pacemaker implantation, even in the absence of anti-arrhythmic drug therapy. Moreover, subgroups of patients whose risk of permanent AF progression differed were identified on the basis of simple baseline clinical variables. The results of this study form the necessary background for the correct management of patients after AV junction ablation and for the planning of future trials in this field.

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Chronic atrial fibrillation in patients with paroxysmal atrial fibrillation, atrioventricular node ablation and pacemakers

EP Europace ◽

10.1053/eupc.1998.0009 ◽

1999 ◽

Vol 1 (1) ◽

pp. 30-34 ◽

Cited By ~ 10

Author(s):

J. M. McComb ◽

G. M. Gribbin

Keyword(s):

Atrial Fibrillation ◽

Multivariate Analysis ◽

Pacemaker Implantation ◽

Atrioventricular Node ◽

Chronic Atrial Fibrillation ◽

Atrial Arrhythmias ◽

Av Node ◽

Surface Ecg ◽

History Of ◽

Atrial Rhythm

Abstract Aims This study examined the factors associated with the development of chronic (or permanent) atrial fibrillation (AF) in patients who had undergone atrioventricular (AV) node ablation with permanent pacing because of paroxysmal AF. Methods A retrospective review of case notes of all 65 consecutive patients identified as having had paroxysmal atrial arrhythmias, AV node ablation and permanent pacemaker implantation was performed. Atrial rhythm was established from all pacing records and from the surface ECG. Treatment with anti-arrhythmic drugs and with warfarin was recorded. A multivariate analysis was undertaken, using atrial rhythm on final ECG and chronic AF as outcome measures. Results During a mean follow-up of 30 months, 42% of patients with paroxysmal AF had developed chronic AF. Multivariate analysis showed that increasing age, history of electrical cardioversion and VVI pacing all contributed to the development of chronic AF. 25/62 patients were taking warfarin, and four had had strokes (2·5%/year). Conclusions The majority of patients with paroxysmal atrial arrhythmias treated with AV node ablation and pacing develop chronic AF eventually. Stroke remains a risk, particularly in those who develop chronic AF.

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Antiplatelet Therapy for Preventing Stroke in Patients With Nonvalvular Atrial Fibrillation and No Previous History of Stroke or Transient Ischemic Attacks

Stroke ◽

10.1161/01.str.0000196914.02476.2c ◽

2006 ◽

Vol 37 (1) ◽

pp. 274-275 ◽

Cited By ~ 2

Author(s):

Maria I. Aguilar ◽

Robert G. Hart

Keyword(s):

Atrial Fibrillation ◽

Antiplatelet Therapy ◽

Previous History ◽

Transient Ischemic Attacks ◽

Nonvalvular Atrial Fibrillation ◽

History Of

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Atrial fibrillation in acute pulmonary embolism: prognostic considerations

Emergency Medicine Journal ◽

10.1136/emermed-2012-202089 ◽

2013 ◽

Vol 31 (4) ◽

pp. 308-312 ◽

Cited By ~ 21

Author(s):

Sérgio Nuno Craveiro Barra ◽

Luís Vilardouro Paiva ◽

Rui Providência ◽

Andreia Fernandes ◽

António Leitão Marques

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Embolism ◽

Previous History ◽

Mortality Prediction ◽

Prognostic Role ◽

Prediction Ability ◽

All Cause Mortality ◽

Increase Risk ◽

History Of ◽

Acute Pe

AimsAlthough it is accepted that atrial fibrillation (AF) may be both the contributing factor and the consequence of pulmonary embolism (PE), data on the prognostic role of AF in patients with acute venous thromboembolism are scarce. Our aim was to study whether AF had a prognostic role in patients with acute PE.MethodsRetrospective cohort study involving 270 patients admitted for acute PE. Collected data: past medical history, analytic/gasometric parameters, admission ECG and echocardiogram, thoracic CT angiography. Patients followed for 6 months. An analysis was performed in order to clarify whether history of AF, irrespective of its timing, helps predict intrahospital, 1-month and 6-month all-cause mortality.ResultsPatients with history of AF, irrespective of its timing (n=57, 21.4%), had higher intrahospital (22.8% vs 13.1%, p=0.052, OR 2.07, 95% CI 0.98 to 4.35), 1-month (35.1% vs 16.9%, p=0.001, OR 3.16, 95% CI 1.61 to 6.21) and 6-month (45.6% vs 17.4%, p<0.001, OR 4.67, 95% CI 2.37 to 9.21) death rates. The prognostic power of AF was independent of age, NT-proBNP values, renal function and admission blood pressure and heart rate and additive to mortality prediction ability of simplified PESI (AF: p=0.021, OR 2.31, CI 95% 1.13 to 4.69; simplified PESI: p=0.002, OR 1.47, CI 95% 1.15 to 1.89). The presence of AF at admission added prognostic value to previous history of AF in terms of 1-month and 6-month all-cause mortality prediction, although it did not increase risk for intrahospital mortality.ConclusionsThe presence of AF, irrespective of its timing, may independently predict mortality in patients with acute PE. These data should be tested and validated in prospective studies using larger cohorts.

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Rapidly Progressive Atrioventricular Block in a Patient with Sarcoidosis

Case Reports in Cardiology ◽

10.1155/2014/372936 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Nagham Saeed Jafar ◽

Warkaa Al Shamkhani ◽

Sunil Roy Thottuvelil Narayanan ◽

Anil Kumar Rajappan

Keyword(s):

Cardiac Sarcoidosis ◽

Previous History ◽

Pacemaker Implantation ◽

Young Patients ◽

Young Male ◽

Pulmonary Involvement ◽

Av Block ◽

History Of ◽

Exercise Induced ◽

Cardiac Manifestations

Cardiac sarcoidosis is a major cause of death in patients with systemic sarcoidosis. Cardiac manifestations are seen in 2.3% of the patients. Atrioventricular (AV) block is one of the common manifestations of cardiac sarcoidosis. Other presentations of cardiac involvement include congestive heart failure, ventricular arrhythmias, and sudden cardiac death. The presence of AV block in young patients should raise the suspicion of sarcoidosis. AV block may be the only manifestation and patients may not have clinical evidence of pulmonary involvement. Here we describe a young male presented with exercise induced AV block rapidly progressing to complete heart block with recurrent syncope needing urgent pacemaker implantation. Factors that suggested an infiltrative process included his young age, rapidly progressive conduction abnormalities in the ECG in the absence of coronary disease, and previous history of cutaneous sarcoidosis.

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